<p> Year Infection Control Risk Assessment</p><p>Program Components Impact (Clinical/Financial/Resources) Infection Prevention Systems Goal</p><p>Ex cel Med Low High Moderate Minimal Fair Good >7 Potential Risks/Problems len t 2 1 3 2 1 2 1 0 Procedures HAI’s Surgical Site Infections 2 2 2 6 SSI-Ortho Join Replacement 1 3 2 6 SSI-plastic surgery 2 3 2 7 SSI-vasectomy 1 1 1 3 Failure of Prevention Activities Lack of Hand Hygiene program 2 3 2 7 Lack of Standard Precautions 1 2 2 5 Lack of TB screening of patients 2 3 2 7 Lack of appropriate prophylactic antibiotic 2 3 2 7 Lack of appropriate OR attire 1 2 2 5 Environment Refrigerator Temp logs 1 1 1 3 Infection from inadequate sterilization 3 2 5 monitoring Improper eating and drinking in the OR 3 6 environment Infection from inadequate air handling 1 3 2 6 Positive Pressure room monitoring 1 2 1 4 Problems with cleaning/high level 1 3 1 5 disinfection Infection related to 3 6 Construction/Renovation Regulated Waste Management 1 3 1 5 Policy and Procedures Lack of current polices or procedures 1 2 1 4 related to-infection control and prevention Failure to follow established policy or 2 3 8 procedures-safe injection practices, single 1 | P a g e Year Infection Control Risk Assessment use devices Preparedness Exposure Plan for disaster preparedness 3 9 Exposure to: Norovirus/influenza/Other 3 9 Respiratory infections-TB /Pertussis Outbreak 3 9 Community ID Risk-Lice/scabies/bed bugs 2 2 7 Employee Health Annual ATD/TB screening Plan 1 3 2 6 Annual Fit Testing 1 2 2 5 Lack of Staff influenza immunization 2 3 2 7 Exposure Plan to Bloodborne 1 3 2 6 Pathogens(BBP) Exposure to Tuberculosis/BBP 3 2 8 Exposure to Pertussis 3 3 2 8 ABX Resistance Organisms MRSA 2 2 2 6 C Dif 1 2 2 5 VRE 3 6 ESBL 3 6</p><p>The Infection Control (IC) Risk Assessment grid is a visual tool to develop IC program priorities and stratify infection risks based on our geography, location in the community, and our patient population. The annual IC Plan is developed based on these risks. </p><p>The Risk Assessment is an ongoing, continual process. If an outbreak should occur it will take precedence over the IC Plan.</p><p>Zero- Process has been going well Low or 1- Processes are initiated and being followed Med or 2-The processes in place are working well and the outcomes are improving and sustaining High or 3- Training or education sessions may need to be scheduled </p><p>2 | P a g e Year Infection Control Risk Assessment</p><p>Risk Assessment Completed on:</p><p>3 | P a g e</p>